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High-density lipoprotein cholesterol and ischemic stroke in the elderly: the Northern Manhattan Stroke Study.
JAMA. 2001 Jun 06; 285(21):2729-35.JAMA

Abstract

CONTEXT

Elevated high-density lipoprotein cholesterol (HDL-C) levels have been shown to be protective against cardiovascular disease. However, the association of specific lipoprotein classes and ischemic stroke has not been well defined, particularly in higher-risk minority populations.

OBJECTIVE

To evaluate the association between HDL-C and ischemic stroke in an elderly, racially or ethnically diverse population.

DESIGN

Population-based, incident case-control study conducted July 1993 through June 1997.

SETTING

A multiethnic community in northern Manhattan, New York, NY.

PARTICIPANTS

Cases (n = 539) of first ischemic stroke (67% aged >/=65 years; 55% women; 53% Hispanic, 28% black, and 19% white) were enrolled and matched by age, sex, and race or ethnicity to stroke-free community residents (controls; n = 905).

MAIN OUTCOME MEASURE

Independent association of fasting HDL-C levels, determined at enrollment, with ischemic stroke, including atherosclerotic and nonatherosclerotic ischemic stroke subtypes.

RESULTS

After risk factor adjustment, a protective effect was observed for HDL-C levels of at least 35 mg/dL (0.91 mmol/L) (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.39-0.72). A dose-response relationship was observed (OR, 0.65; 95% CI, 0.47-0.90 and OR, 0.31; 95% CI, 0.21-0.46) for HDL-C levels of 35 to 49 mg/dL (0.91-1.28 mmol/L) and at least 50 mg/dL (1.29 mmol/L), respectively. The protective effect of a higher HDL-C level was significant among participants aged 75 years or older (OR, 0.51; 95% CI, 0.27-0.94), was more potent for the atherosclerotic stroke subtype (OR, 0.20; 95% CI, 0.08-0.50), and was present in all 3 racial or ethnic groups studied.

CONCLUSIONS

Increased HDL-C levels are associated with reduced risk of ischemic stroke in the elderly and among different racial or ethnic groups. These data add to the evidence relating lipids to stroke and support HDL-C as an important modifiable stroke risk factor.

Authors+Show Affiliations

Neurological Institute, 710 W 168 St, New York, NY 10032, USA. rls1@columbia.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11386928

Citation

Sacco, R L., et al. "High-density Lipoprotein Cholesterol and Ischemic Stroke in the Elderly: the Northern Manhattan Stroke Study." JAMA, vol. 285, no. 21, 2001, pp. 2729-35.
Sacco RL, Benson RT, Kargman DE, et al. High-density lipoprotein cholesterol and ischemic stroke in the elderly: the Northern Manhattan Stroke Study. JAMA. 2001;285(21):2729-35.
Sacco, R. L., Benson, R. T., Kargman, D. E., Boden-Albala, B., Tuck, C., Lin, I. F., Cheng, J. F., Paik, M. C., Shea, S., & Berglund, L. (2001). High-density lipoprotein cholesterol and ischemic stroke in the elderly: the Northern Manhattan Stroke Study. JAMA, 285(21), 2729-35.
Sacco RL, et al. High-density Lipoprotein Cholesterol and Ischemic Stroke in the Elderly: the Northern Manhattan Stroke Study. JAMA. 2001 Jun 6;285(21):2729-35. PubMed PMID: 11386928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-density lipoprotein cholesterol and ischemic stroke in the elderly: the Northern Manhattan Stroke Study. AU - Sacco,R L, AU - Benson,R T, AU - Kargman,D E, AU - Boden-Albala,B, AU - Tuck,C, AU - Lin,I F, AU - Cheng,J F, AU - Paik,M C, AU - Shea,S, AU - Berglund,L, PY - 2001/6/21/pubmed PY - 2001/6/29/medline PY - 2001/6/21/entrez SP - 2729 EP - 35 JF - JAMA JO - JAMA VL - 285 IS - 21 N2 - CONTEXT: Elevated high-density lipoprotein cholesterol (HDL-C) levels have been shown to be protective against cardiovascular disease. However, the association of specific lipoprotein classes and ischemic stroke has not been well defined, particularly in higher-risk minority populations. OBJECTIVE: To evaluate the association between HDL-C and ischemic stroke in an elderly, racially or ethnically diverse population. DESIGN: Population-based, incident case-control study conducted July 1993 through June 1997. SETTING: A multiethnic community in northern Manhattan, New York, NY. PARTICIPANTS: Cases (n = 539) of first ischemic stroke (67% aged >/=65 years; 55% women; 53% Hispanic, 28% black, and 19% white) were enrolled and matched by age, sex, and race or ethnicity to stroke-free community residents (controls; n = 905). MAIN OUTCOME MEASURE: Independent association of fasting HDL-C levels, determined at enrollment, with ischemic stroke, including atherosclerotic and nonatherosclerotic ischemic stroke subtypes. RESULTS: After risk factor adjustment, a protective effect was observed for HDL-C levels of at least 35 mg/dL (0.91 mmol/L) (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.39-0.72). A dose-response relationship was observed (OR, 0.65; 95% CI, 0.47-0.90 and OR, 0.31; 95% CI, 0.21-0.46) for HDL-C levels of 35 to 49 mg/dL (0.91-1.28 mmol/L) and at least 50 mg/dL (1.29 mmol/L), respectively. The protective effect of a higher HDL-C level was significant among participants aged 75 years or older (OR, 0.51; 95% CI, 0.27-0.94), was more potent for the atherosclerotic stroke subtype (OR, 0.20; 95% CI, 0.08-0.50), and was present in all 3 racial or ethnic groups studied. CONCLUSIONS: Increased HDL-C levels are associated with reduced risk of ischemic stroke in the elderly and among different racial or ethnic groups. These data add to the evidence relating lipids to stroke and support HDL-C as an important modifiable stroke risk factor. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/11386928/High_density_lipoprotein_cholesterol_and_ischemic_stroke_in_the_elderly:_the_Northern_Manhattan_Stroke_Study_ L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/285/pg/2729 DB - PRIME DP - Unbound Medicine ER -